Monday, September 19th, 2016

Stay Kind

Andrew Cruz, MD

Perhaps the most resilient quality you can retain, as you progress through medical training, is to remain kind.

During my first two years of medical school, students with the highest scores always impressed me.  They seemed to learn at a pace and answer questions with a confidence that I both admired and envied. Third and fourth year of medical school, I found myself impressed by the workhorses.  They would arrive first and leave last, sacrificing the currency of time rotation after rotation. Their drive seemed to know no limit. Now I am a resident, and you know what impresses me most? It is that which, like perfect scores and working extra hours, is rare–humanity.

I have seen the innate humanity with which so many students begin medical school slowly erode away by the time they reach residency.  I’m talking about that trust students have before a patient lies to them.  That empathy students have before they re-admit a patient for noncompliance.  That extra five minutes students spend learning more about a patient’s family, hopes, and dreams before they become overwhelmed with administrative responsibilities. That genuine feeling they are changing the world, dampened when suffering is what they see day after day. I am impressed meeting a resident who remembers patients are humans and not tasks. I am impressed when I meet a resident who takes time to ask their fellow resident how they are and, even more, when they really listen to their answer. In a time when physician suicide headlines have become commonplace, we have never needed supportive, kind, and humane doctors more.

I have made a point to ask the people I work with ‘how are you?’ at least every other day.  I have been surprised by how often the answer is not “Great” or “Good” but “I’m having a tough day” or “I think I’m depressed” or “Do you have a second to talk?”  The problem is that doctors have been conditioned to focus on our jobs, and we have forgotten about each other.  We have forgotten that patients are not obligations but beautifully flawed creatures just like us. We have forgotten that doctors have regrets and illnesses, and that they bleed. We have forgotten that we are all here together. This frightens me because I think the majority of students become physicians because they genuinely desire to help and heal. But then, anxiety of failure, threat of lawsuits, ungrateful patients, a stressed colleague who takes out his frustration on you, long hours, and the burden of loans, all start chipping away at your humanity until all that is left is a jaded shell of what was.

Resiliency is the ability of an object to return to its original form after being bent, compressed, or stretched out of shape. Medical training, inherently difficult, will try to change your shape. Let it change your critical thinking skills, let it change your knowledge base, but do not let it change YOU. It will not come naturally; you will have to work at it. You will have to ask your colleagues how they are. You will have to care, sometimes begrudgingly so, about the answer. You will have to keep yourself accountable when the workload of being a physician begins to make you forget the reason you filled out the application for medical school all those years ago. You will have to make a point to remark about your patient’s strengths as well as their pathologies.  Your colleagues, your patients, and the rest of the world do not need you to make higher scores or to work more hours, they need you to care more.  To care like you did when you started this journey.

About Andrew (Andy) Cruz, MD

Andrew Cruz headshotAndrew (Andy) Cruz is a psychiatry resident, classically trained concert pianist, composer, and writer. He was born and raised in Amarillo, Texas and attended undergraduate and graduate school at Texas Tech University. Andrew majored in Music with a concentration in Piano and earned a Graduate Certificate in Piano Pedagogy. He worked his way through school by being a campus tour guide, restaurant manager, bartender, and choir director. While in Medical School he served as president of his class, president of the Texas Tech University Health Sciences Center Gold Humanism honor society, and on the admissions committee. He graduate in May of 2015 and was honored to be able to address his class at the graduation ceremony. He is currently a resident at Massachusetts General Hospital/McLean/Harvard Medical School. Dr. Cruz aims to develop curricula for mental health education in the nation’s school systems and to increase access to mental health care for all populations, especially the indigent and uninsured, and to decrease stigma associated with psychiatric pathologies.  You can contact Dr. Cruz on Twitter @openheartpsych or by email andystephencruz@gmail.com. All of Dr. Cruz’s views are personal and not those of his institution.

 


2 thoughts on “Stay Kind

  1. I wish it was acceptable for doctors to express their feelings, to be human. We talk about it and write about it like here, but in reality doctor’s aren’t allowed to be human in the workplace. A doctor who thinks he may have depression must choose between professional help and their career. Many states require that physicians who receive counseling report that to the state medical board, ultimately this is documented on the record and can be used to limit their ability to work, keep or find a job in the future.

    We aren’t allowed to have bad days, to need help. We are expected to be perfect all the time.

    One day I hope all this talk from Good people like dr Cruz leads to actual change. For now, I expect that physician suicide and burnout will continue to top the headlines.

  2. Hi Dr. Cruz,

    I am a second-year medical student currently getting my MD/MPH degree. Our program- with public health integrated throughout the four years of medical school- emphasizes the aspects of humanity that can so easily become neglected and forgotten in MD-only programs. Today I was particularly moved by a classmate’s presentation as he began with a picture of a beautiful little girl who was diagnosed with acute lymphoblastic leukemia (which the presentation was about) and noted that before we get started, we need to remember that when we speak about these diagnoses we need to truly think about the patients and picture them in our minds and not speak of them as just a disease. It was a great way to begin his presentation as it put us all in the correct mindset when so many students were ready to jump right into the pathophysiology of ALL.

    I just wanted to let you know… that I appreciate this post. I hope you continue to make strides in incorporating mental health plans into curricula, and I hope you continue to ask others how they are.
    These particular topics (the importance of remembering that we’re all people, with feelings, who need to support each other) have been on my mind a lot lately as I’m trying to get through the grind that is hematology-oncology.

    So thank you.
    Please continue thinking of others.
    As a medical student, it’s hard for me to watch people lose parts of themselves that were once responsible for the desire to go into medicine. I fear it will happen to me despite my every effort to remain optimistic in all aspects of life, and to remain kind.
    Reading this post was a nice reminder that not everybody stops caring… you are one of those people who continued to hold your head high. My parents are another example, and I’m very blessed to have two incredibly kind and caring physicians as parents. I learned growing up that to stop caring and to stop being kind was never an option. But it’s a shock to come to medical school where unfortunately, that perspective is shared by the minority rather than the majority of people.

    So again, thank you. And I wish you the best. And I hope you are well.

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